Remote Australia Online

Summary ■The RHD Endgame Strategy: the blueprint to eliminate rheumatic heart disease in Australia by 2031 (the Endgame Strategy) is the blueprint to eliminate rheumatic heart disease (RHD) in Australia by 2031. Aboriginal and Torres Strait Islander people live with one of the highest per capita burdens of RHD in the world. ■The Endgame Strategy synthesises information compiled across the 5-year lifespan of the End Rheumatic Heart Disease Centre of Research Excellence (END RHD CRE). Data and results from priority research projects across several disciplines of research complemented literature reviews, systematic reviews and narrative reviews. Further, the experiences of those working in acute rheumatic fever (ARF) and RHD control and those living with RHD to provide the technical evidence for eliminating RHD in Australia were included. ■The lived experience of RHD is a critical factor in health outcomes. All future strategies to address ARF and RHD must prioritise Aboriginal and Torres Strait Islander people's knowledge, perspectives and experiences and develop co-designed approaches to RHD elimination. The environmental, economic, social and political context of RHD in Australia is inexorably linked to ending the disease. ■Statistical modelling undertaken in 2019 looked at the economic and health impacts of implementing an indicative strategy to eliminate RHD by 2031. Beginning in 2019, the strategy would include: reducing household crowding, improving hygiene infrastructure, strengthening primary health care and improving secondary prophylaxis. It was estimated that the strategy would prevent 663 deaths and save the health care system $188 million. ■The Endgame Strategy provides the evidence for a new approach to RHD elimination. It proposes an implementation framework of five priority action areas. These focus on strategies to prevent new cases of ARF and RHD early in the causal pathway from Streptococcus pyogenes exposure to ARF, and strategies that address the critical systems and structural changes needed to support a comprehensive RHD elimination strategy.

Arnhem Land Fire Abatement (Northern Territory) Limited (ALFA) is a non-profit company established to make a financial return from savanna fire management. It operates as a charitable entity to ensure that its earnings benefit the Aboriginal landowners of Arnhem Land, many living in deep poverty. ALFA is unusual because it must operate at the intersection of Western and customary domains. It catalyses and supports the carbon emission avoidance activities of Aboriginal ranger groups and traditional landowners, who deploy customary and Western fire-management approaches at a large regional scale. Simultaneously, ALFA manages the Australian Carbon Credit Units that it earns, either selling them under contract to the Australian government or to corporate purchasers, or saving them for later sale. In this article we examine the first five years of ALFA since its establishment in 2015 ? its origins and more recent history, its achievements and its governance. We then examine several climatic, financial, environmental and politico-cultural challenges that it faces operating in the Australian carbon and conservation economies. We show from diverse perspectives how, during a late-capitalist period of extreme climatic uncertainty, ALFA has evolved into an established model of sustainable postcolonial possibility, as ?no ordinary? company.

The effective use of technology to improve people’s health depends on factors beyond the technologies themselves, such as the diseases that affect a population, ease of access to the actual technologies and the level of motivation of the person interacting with the technology. This chapter specifically explores some of these considerations in the context of Australia. Additionally, rural and remote areas of any country or continent will face unique challenges in terms of incorporating technology into healthcare delivery. This chapter will, therefore, examine how technology is being applied in remote and rural Australia giving examples through case studies. It also outlines emerging opportunities for applying digital technologies into the future to support healthier communities in an affordable, accessible way.

Recommendation 1 2.28: The committee recommends that all Australian Government and state/territory agencies, provide the Australian Institute of Health and Welfare with reports and publications as they are published, as well as statistics on an annual basis, to ensure that the Closing the Gap Clearinghouse is a relevant evidence base for policy makers. Recommendation 2 2.43: The committee recommends that the COAG work on the National Strategy for Food Security in Remote Indigenous Communities include an analysis of alternative agriculture to improve the affordability, quality and availability of fresh fruit and vegetables in regional and remote Indigenous communities. Recommendation 3 2.50: The committee recommends that the Australian Government expand the remit of the Coordinator General for Remote Indigenous Services' reporting mandate for basic service and infrastructure in all regional and remote Indigenous communities with over 200 residents. The committee considers that the Coordinator General should be afforded additional resources to undertake such an expanded reporting role. Recommendation 4 2.57: The committee notes the consultation being undertaken in developing local implementation plans but considers that as a matter of practice, consultation plans which are not readily accessible to the public should be made public prior to consultation being undertaken. Recommendation 5 2.72: The committee recommends that on a monthly basis the Australian Government publish the number and location of new, rebuilt or refurbished homes completed under the National Partnership Agreement on Remote Indigenous Housing program. Recommendation 6 2.73: The committee also recommends that the Coordinator General for Remote Indigenous Services conduct a detailed analysis of the National Partnership Agreement on Remote Indigenous Housing in his next six monthly report. Recommendation 7 2.118: Noting the success of the Sporting Chance Program, the committee recommends that the Australian Government investigate programs for other extra curricular activities such as a program for students interested in the arts. Recommendation 8 2.176: The committee recommends that the evaluation mechanisms that underpin COAG's investment of the $100 million Tackling Smoking initiative be publicly released to ensure that this funding provides a tangible difference on the ground in communities. Recommendation 9 2.219: Given the evidence that the committee has received about problems with funding models, the committee considers that COAG should expedite implementation of the Coordinator General for Remote Indigenous Services' recommendation to examine the use of more flexible funding approaches which aggregate departmental funding into a master contract with each National Partnership Agreement on Remote Service Delivery community. Recommendation 10 3.15: The committee recommends that all state and territory governments consider the publication of a Quarterly Report in line with that published by the Queensland Government and that this information feed into the Council of Australian Governments baseline data collection process. Recommendation 11 3.34: The committee recommends that the evaluation of the Cape York Welfare Reform trial be made public to inform other governments about the results of the program and its applicability to other regional and remote Indigenous communities. Recommendation 12 3.84: The committee recommends that the Ministerial Council for Education, Early Childhood Development and Youth Affairs expand the policy on attendance currently in the draft Indigenous Education Action Plan to include the need for measures that facilitate reintegration of students who have missed large amounts of schooling but recommence attending school as the result of attendance measures. Recommendation 13 3.248: The committee recommends that the Australian Health Ministers Conference develop a framework specifying interoperability between social and emotional wellbeing services and clinical mental health services. Recommendation 14 3.361: The committee recommends that Queensland Corrections consider including routine hearing assessments in the induction and assessment process for persons newly entering the corrective services system.

Evaluative studies on the effectiveness and outcomes of integrated models responding to Domestic and Family Violence (DFV) remain limited (Productivity Commission 2020). Despite this, most jurisdictions see integrated models as best practice for effectively responding to DFV. This research brief describes how these models are broadly conceived, how they have been applied in Australia, where improvements have been made, and how they require further changes to support Indigenous victims particularly those in remote and rural settings. Similarly, this research brief highlights best practice to facilitate the improvement of practices, processes, and evaluation strategies for ensuring Indigenous families and communities remain at the ‘centre’ of future developments in this space.

We offer this submission to assist the deliberations of the Committee regarding the Cashless Debit Card. Having looked thoroughly at the evidence and policy context, we provide a number of observations. We do not believe that available evidence supports the proposition that either the compulsory Cashless Debit Card or income management in the Northern Territory are making substantive, positive contributions to the vast majority of participants’ lives and effectively addressing the challenges these communities face. Furthermore, despite efforts to improve the technical performance of the Cashless Debit Card, the program continues to have unintended negative consequences for some participants. Evidence we have examined suggests that the program may be useful for some individuals as a voluntary measure or if adopted on a case-by-case basis according to strict criteria, in conjunction with the provision of case management and ‘wrap around’ support services to that individual. We also recognise that policy making must be based on both evidence and principles. We appreciate that the Prime Minister has recently embraced the principle of shared decision-making with First Nations and listening to Indigenous voices in policy impacting on them. The proposed legislative policy change will have significant and disproportionate impact on First Nations people, and that principle should apply. Furthermore, there is an opportunity-cost in alternative, more effective measures foregone in continuing this program. Different policies can tackle the issues more successfully. While we believe that the current evidence does not support the continuation of a mandatory CDC or income management in the Northern Territory, it would be prudent for Parliament to await the public release of the Second Impact Evaluation. At the very least, Members of Parliament and Senators should pause their deliberation on this Bill until after that evaluation report is released and its findings can be digested by affected communities and this Committee.

Population growth in developed nations has become increasingly concentrated towards metropolitan areas. In Australia, around 80% of national growth derives from its largest 7 cities but in sparsely populated areas, recent growth tends towards stagnation or decline. For these regions, there are no studies which systematically analyse a key aspect for population growth - drivers for population retention. Our study engages a life-stage approach to the analysis of a large survey about migration motivations and drivers as they relate to the Northern Territory of Australia. The Territory and Me survey was conducted during 2019 with more than 5200 current and former residents participating. In this study, we applied odds ratios, binomial regression and correspondence analysis to demonstrate the most important demographic and socio-economic characteristics associated with retention rates and factors for staying or leaving. Motivations for leaving were explained largely by two factors, one strongly associated with age and the other influenced by relative levels of familial and financial responsibilities. Other results highlight the importance of overseas born residents for their high retention rates across all life-stages, home ownership and having children resident in the Northern Territory. These findings can inform policy initiatives to positively influence future retention of people in different life-stages and ultimately help address low population growth for sparsely populated areas.

Background Aboriginal and Torres Strait Islander people experience a greater burden of disease and die younger than non-Indigenous Australians, with Aboriginal people living in remote areas of the Northern Territory of Australia having the lowest life expectancy estimates. Despite a high burden of chronic disease among Aboriginal and Torres Strait Islander people, access to specialist health services remains low and models of care that increase engagement, may improve health outcomes. Methods We describe client and staff perspectives of a model of clinical genetics services provided by the MJD Foundation (MJDF) in geographically and culturally complex contexts within the Northern Territory of Australia. We seek to understand the MJDF model’s success in supporting Aboriginal families with the familial, neurodegenerative condition Machado-Joseph disease and how it could be applied in the provision of other specialist services. Thematic analysis was undertaken on semi-structured interviews with primary health care staff (n = 2), Non-Aboriginal MJDF Staff (n = 7) and Aboriginal MJDF Clients / Community workers (n = 13). Results Four key themes regarding the MJDF model of service delivery were identified with the service being; 1) client led 2) accepting of various understandings of genetic disease causation 3) focused on relationships, continuity and trust between the service provider and the clients, and 4) committed to incorporating an inclusive whole-of-family practice. The MJDF model takes a community-based, person-and family-centred approach to successfully deliver effective specialist genetic health services in remote community settings. We propose that these approaches have broad application in the future design and delivery of specialist health services particularly in culturally complex settings.

The challenge of aggregating research information for Torres Strait exists. Currently, research is often done in isolation. Now, more than ever, the aggregation of Torres Strait research information is needed to address climate change. Information aggregation leads to informed agency. Informed agency leads to best possible climate change policies and actions. Information markets can facilitate informed agency and climate change project selection and valuation. We demonstrate the benefit of employing a particular information market approach to facilitate informing agents in a real world workshop setting. The workshop considers how best to address the Torres Strait climate change problem. Our a priori theoretical model motivates a specific hypothesis on the functional form of information uptake by agents (workshop participants). Analysis of collected data supports our hypothesis. The information market implies a valuation of climate change project information. It is estimated to be as valuable as a typical flood insurance premium.

The idea that freedom should be an explicit goal of development schemes has become popular over recent decades. In this article we consider ways in which the concept is applied to remote Indigenous Australia, such as in Noel Pearson’s invocations of Amartya Sen’s concept of ‘development as freedom’. We draw on the work of governmentality theorists that critically probes the notion of freedom and the ways in which it is tied to its seeming antonym, discipline. We ask what understandings of remote Indigenous Australian life, what ways of thinking about Indigenous futures, may be eclipsed by approaching development aspirations through this (neo-)liberal prism of freedom.

Co-production between scientific and Indigenous knowledge has been identified as useful to generating adaptation pathways with Indigenous peoples, who are attached to their traditional lands and thus highly exposed to the impacts of climate change. However, ignoring the complex and contested histories of nation-state colonisation can result in naïve adaptation plans that increase vulnerability. Here, through a case study in central Australia, we investigate the conditions under which co-production between scientific and Indigenous knowledge can support climate change adaptation pathways among place-attached Indigenous communities. A research team including scientists, Ltyentye Apurte Rangers and other staff from the Central Land Council first undertook activities to co-produce climate change presentations in the local Arrernte language; enable community members to identify potential adaptation actions; and implement one action, erosion control. Second, we reflected on the outcomes of these activities in order to unpack deeper influences. Applying the theory of articulation complexes, we show how ideologies, institutions and economies have linked Indigenous societies and the establishing Australian nation-state since colonisation. The sequence of complexes characterised as frontier, mission, pastoral, land-rights, community-development and re-centralisation, which is current, have both enabled and constrained adaptation options. We found knowledge co-production generates adaptation pathways when: (1) effective methods for knowledge co-production are used, based on deeply respectful partnerships, cultural governance and working together through five co-production tasks—prepare, communicate, discuss, bring together and apply; (2) Indigenous people have ongoing connection to their traditional territories to maintain their Indigenous knowledge; (3) the relationship between the Indigenous people and the nation-state empowers local decision-making and learning, which requires and creates consent, trust, accountability, reciprocity, and resurgence of Indigenous culture, knowledge and practices. These conditions foster the emergence of articulation complexes that enable the necessary transformative change from the colonial legacies. Both these conditions and our approach are likely to be relevant for place-attached Indigenous peoples across the globe in generating climate adaptation pathways.

The use of digital technology by young remote First Nations Australians remains under-investigated. This research followed the everyday lives of 30 birth-to-aged 6-year-old children from three distinct and diverse remote communities in the Ngaanyatjarra and Pintupi region of the Western Desert. This article explores the intertwined nature of new cultural variations, such as digital technology in daily life, and the acquisition and transmission of cultural practices and processes. Whilst digital technology is in proliferation, argument is made that, regardless of the influx of digital devices and access, 'traditional' (First Nations systems) childhood socialisation values and practices remain relatively unchanged. Despite exposure to Western digital technologies, findings indicate Ngaanyatjarra and Pintupi practices, values, morals and dispositions are not being replaced by 'modern' culture. Further, exploring youngsters' digital technology use may shed light on cultural variations to First Nations socialisation practices and core societal values.

Peer Workers are the most underutilised, valuable resource available to rural and remote mental health services and communities. Evidence has confirmed the efficacy of peer work, yet their historically slow uptake has robbed communities and individuals of the opportunity to be supported by staff who can provide an added layer of assistance as part of a multidisciplinary team or beneficial alternative to conventional treatments. This chapter seeks to inspire confidence in all stakeholders involved in rural and remote communities to engage with the valuable, fast growing, competent, and readily available Peer Workforce. It discusses the evidence, value, and efficacy of peer work in rural and remote mental health services and communities. The high level of stigma and discrimination surrounding mental health in rural and remote communities and the desperately low level of “homegrown” mental health personnel who know that the local people, customs, languages, and land can be rectified by the employment of Peer Workers from within the community they live. This chapter asserts that the ethical and practical conclusions regarding peer work in rural and remote communities are that supported, respected, and valued Peer Workers are vital to the much needed reform of mental health services. It sets out the main reasons for this by utilising recognised, published research and academic papers, along with case studies utilising peer work in three very different rural and remote areas in Australia which are utilised to demonstrate and authenticate the desperate need for and beneficial effects of Peer Work.

Background Globally, rates of hyperglycaemia in pregnancy are highest among Indigenous women. The highest prevalence has been documented among Aboriginal women in the Northern Territory of Australia. Despite knowledge of this for over two decades, there has been very limited examination of the specific needs and experiences of Aboriginal women regarding this condition. Question How do Aboriginal women with hyperglycaemia in pregnancy understand and experience this condition, and how can their care be improved? Methods A phenomenological methodology underpinned semi-structured in-depth interviews with 35 Aboriginal women and seven health professionals across the Northern Territory. Data were inductively analysed. Findings The findings revealed that in general, participants in this study could recite simple health messaging regarding diabetes (e.g. ‘no sugar’), but many lacked in-depth knowledge and this affected the management of their condition. Nevertheless, many identified pregnancy as a powerful motivator for change, signalling scope to improve health messaging. Women consistently expressed the need for diabetes education that was culturally appropriate, a clear desire for maternity care that was family-centred, based on respectful relationships with the same care provider, and respected Aboriginal ways of knowing and being. Conclusion Existing health messaging around hyperglycaemia in pregnancy has limited reach with Aboriginal women in the Northern Territory. Reducing the burden of hyperglycaemia in pregnancy among these women requires a sustained commitment to redesign of maternity and diabetes care to incorporate the cultural and social context of women’s lives.

Since 2008, the Northern Territory Point-of-Care Testing Program has improved patient access to pathology testing for acute and chronic disease management for remote health services.To evaluate the analytical quality, service delivery, and clinical utility of an expanding remote point-of-care testing network.Four years (2016–2019) of data on analytical quality, test numbers, and training statistics and 6 months of clinical point-of-care testing data from Abbott i-STATs at remote health services throughout the Northern Territory were analyzed to assess analytical performance, program growth, and clinical utility.From 2016 to 2019, point-of-care test numbers increased, with chemistry and blood gas testing more than doubling to 8500 and 6000 tests, respectively, troponin I testing almost doubling (to 6000), and international normalized ratio testing plateauing at 8000 tests. Participation in quality control and proficiency testing was high, with quality comparable to laboratory-based analytical goals. A shift toward flexible training and communication modes was noted. An audit of point-of-care test results demonstrated elevated creatinine, associated with chronic kidney disease management, as the most common clinically actionable patient result.The Northern Territory Point-of-Care Testing Program provides high quality point-of-care testing within remote primary health services for acute and chronic patient management and care. Clinical need, sound analytical performance, flexibility in training provision, and effective support services have facilitated the sustainability of this expanding point-of-care testing model in the remote Northern Territory during the past 11 years.

There are multiple structural and practical barriers to Aboriginal young people with cognitive disability in remote areas receiving the support and services they need. Multidisciplinary mixed-methods research over the past decade has provided evidence of the ways that many such young people end up with complex support needs and being ‘managed’ by police and justice agencies in the absence of appropriate early intervention, transition support and community-based options. This article presents and synthesises knowledge generated by this body of work and contextualises it within the experiences and trajectory of a young Aboriginal woman with cognitive disability and complex support needs from a remote town. This case study is drawn from a New South Wales linked administrative dataset containing data from health, housing, disability, human services, police, legal, court and justice agencies on a cohort of people who have been incarcerated. The article draws out key principles and strategies to suggest what a community-led, holistic service response could have looked like for Casey.

Poor diet and lifestyle exposures are implicated in substantial global increases in non-communicable disease burden in low-income, remote, and Indigenous communities. This observational study investigated the contribution of the fecal microbiome to influence host physiology in two Indigenous communities in the Torres Strait Islands: Mer, a remote island where a traditional diet predominates, and Waiben a more accessible island with greater access to takeaway food and alcohol. Counterintuitively, disease markers were more pronounced in Mer residents. However, island-specific differences in disease risk were explained, in part, by microbiome traits. The absence of Alistipes onderdonkii, for example, significantly (p=0.014) moderated island-specific patterns of systolic blood pressure in multivariate-adjusted models. We also report mediatory relationships between traits of the fecal metagenome, disease markers, and risk exposures. Understanding how intestinal microbiome traits influence response to disease risk exposures is critical for the development of strategies that mitigate the growing burden of cardiometabolic disease in these communities.

Aims/hypothesis: In recent years, several new medications for the treatment of type 2 diabetes have been released and some evidence indicates sociodemographic disparity in their utilisation. We sought to investigate sociodemographic disparities in receipt of diabetes medications across Australia. Methods: This study included 1,203,317 people with type 2 diabetes registered on the Australian National Diabetes Services Scheme (NDSS) followed from 2007 to 2015. The NDSS was linked to the Australian pharmaceutical claims database. We investigated trends in diabetes medication dispensing and variation in dispensing by sociodemographic strata. Results: Compared with individuals in the least disadvantaged areas, those in the most disadvantaged quintile were less likely to receive dipeptidyl peptidase-4 inhibitors (DPP4is), glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium–glucose cotransporter 2 inhibitors (SGLT2is) in the first year of availability (OR [95% CI] for most vs least disadvantaged: 0.78 [0.75, 0.82], 0.65 [0.60, 0.71] and 0.89 [0.84, 0.95], respectively). These disparities dissipated over time for DPP4is and SGLT2is but remained significant for GLP-1RAs. The OR (95% CI) of receiving DPP4is, GLP-1RAs and SGLT2is in the first year of availability for people in remote areas vs major cities was 0.46 (0.39, 0.54), 0.46 (0.35, 0.61) and 0.71 (0.59, 0.84), respectively. These disparities remained significant through to 2015. Conclusions/interpretation: People with diabetes in more disadvantaged areas are less likely to receive newer diabetes medications, although this effect decreased over time. However, there are considerable and persistent differences in receipt of newer diabetes medications between major cities and remote areas of Australia.

Introduction: Cancer patients in Australia’s Northern Territory (NT) face unique challenges to accessing cancer-related community and allied health services (referred here as ‘health services’). This is in part due to the NT’s unique geographic, socioeconomic and demographic profile. This paper describes the use of health services by cancer patients in the NT. Methods: Adult cancer patients attending appointments at a cancer centre in Darwin, NT and who were diagnosed within the past five years were invited to participate in face-to-face interviews about their use of allied and community health services. A descriptive analysis of health services utilization was conducted. Results: Of the 76 participants interviewed, 63% identified as non-Indigenous, 53% female and 45% lived in very remote areas. Mean age at interview was 58.7 years (SD 13.2). Overall, 82% of participants utilized at least one health service since their cancer diagnosis. All Indigenous participants used at least one service, while 28% of non-Indigenous participants did not use any health service. The services most frequently used by participants were community services (42%) and information sources (40%). Conclusion: The findings from this study suggest there is variation in the type of community and allied health services used by NT cancer patients across clinical and demographic groups (including Indigenous status). Further qualitative enquiry is needed to better understand this variation, which may reflect differences in service preference, accessibility, health literacy of patients or patient engagement. Such knowledge may inform service delivery improvements to better support cancer patients through their cancer care pathway.

INTRODUCTION: Access to essential medicines is a human right and an objective of the National Medicines Policy in Australia. Health workforce distribution characteristics in remote Australia implies registered nurses (RNs) may find themselves responsible for a broader range of activities in the medication management cycle than they would be elsewhere in the nation. The regulation of health professionals and their training requirements provides essential but complex protections for the public. These protections include the National Registration and Accreditation Scheme for health practitioners and the Australian Health Practitioner Regulation Agency. Other levels of control or regulation are also exerted over health professionals via mechanisms such as salaries and funding arrangements, insurance requirements, admitting rights to healthcare facilities, and legislation controlling the use of medicines and therapeutic devices. This study aimed to examine national legislation and regulations concerning the use of medications from a nursing perspective, focusing on the context of health service delivery in remote areas. METHODS: Australian state and territory medicines legislation and regulations was interrogated for answers to the questions 'Can an RN prescribe a medication?', 'Can an RN dispense a medication?', 'Can an RN supply or issue a medication?' and 'Can an RN administer a medication?' RESULTS: Inconsistencies were identified nationally in the names and general structure of the legislation, the location of information relating to authorised roles with regards to medications and key terms used to describe medicines and the elements of the medication management cycle. Administrations of Schedule 4 and 8 medicine according to an order from an authorised prescriber are the only nationally consistent roles RNs are authorised to undertake with regards to medicines. Twenty-eight variations were identified with regards to additional authorisations for RNs. CONCLUSION: RNs make up more than half of the registered Australian health professional workforce and are the most consistently distributed across the nation, yet their legislated responsibilities in relation to working with medicines are inconsistent. Given the inconsistencies, RNs providing health care in remote Australia may be unable to undertake aspects of the medication management cycle that their work environment demands in the best interest of their patients and absence of other healthcare providers. The lack of legislative consistency nationally for medicines in Australia is likely to impede timely access to medications for patients. Regulatory inconsistencies may also result in RNs working well below or beyond their legal scope of practice, thereby creating clinical and workforce risks. Such risks are a significant matter for remote health service provision. Resolving these issues will require a collaborative national approach with consideration given to how the health workforce is distributed, current nursing responsibilities and relevant service delivery models for remote Australia.

Economic development in Australia, especially resource development, has purportedly long been pursued for the greater good of the nation and its people and is thus often equated to moral progress. Yet, despite the celebrated spoils of the resources sector, Indigenous Australians have persistently been denied the benefits of economic progress owing to a history of colonialism, dispossession, segregation and assimilation policies, which have contributed to the marginalisation of Indigenous people to the present day. Thus, this article asks whether orthodox resource-led development has a social licence, and importantly for whose greater good? This paper applies a social licence lens to current water extraction proposals for Western Australia's remote Martuwarra Fitzroy River region where ecological values have largely remained intact and Indigenous people make up over 60 per cent of the population. It is argued the proposed water extraction plans hold little promise of serving either local or national interests when judged holistically and risk perpetuating adverse socio-cultural and ecological legacies from extractive activities for local Indigenous peoples. Within the Martuwarra Fitzroy River context, this paper seeks to redefine the ‘greater good’ and to articulate ‘socially licenced’ development alternatives without the ecological and cultural trade-offs typical of orthodox development.

Changed fire regimes and the introduction of rabbits, cats, foxes, and large exotic herbivores have driven widespread ecological catastrophe in Australian arid and semi-arid zones, which encompass over two-thirds of the continent. These threats have caused the highest global mammal extinction rates in the last 200 years, as well as significantly undermining social, economic, and cultural practices of Aboriginal peoples of this region. However, a new and potentially more serious threat is emerging. Buffel grass (Cenchrus ciliaris L.) is a globally significant invader now widespread across central Australia, but the threat this ecological transformer species poses to biodiversity, ecosystem function, and culture has received relatively little attention. Our analyses suggest threats from buffel grass in arid and semi-arid areas of Australia are at least equivalent in magnitude to those posed by invasive animals and possibly higher, because unlike these more recognized threats, buffel has yet to occupy its potential distribution. Buffel infestation also increases the intensity and frequency of wildfires that affect biodiversity, cultural pursuits, and productivity. We compare the logistical and financial challenges of creating and maintaining areas free of buffel for the protection of biodiversity and cultural values, with the creation and maintenance of refuges from introduced mammals or from large-scale fire in natural habitats. The scale and expense of projected buffel management costs highlight the urgent policy, research, and financing initiatives essential to safeguard threatened species, ecosystems, and cultural values of Aboriginal people in central Australia.

Point-of-care (POC) testing has significant potential application in rural and remote Australian communities where access to laboratory-based pathology testing is often poor and the burden of chronic, acute, and infectious disease is high.To explore the clinical, operational, cultural, and cost benefits of POC testing in the Australian rural and remote health sector and describe some of the current challenges and limitations of this technology.Evidence-based research from established POC testing networks for chronic, acute, and infectious disease currently managed by the International Centre for Point-of-Care Testing at Flinders University are used to highlight the experience gained and the lessons learned from these networks and, where possible, describe innovative solutions to address the current barriers to the uptake of POC testing, which include governance, staff turnover, maintaining training and competency, connectivity, quality testing, sustainable funding mechanisms, and accreditation.Point-of-care testing can provide practical and inventive opportunities to revolutionize the delivery of pathology services in rural and remote sectors where clinical need for this technology is greatest. However, many barriers to POC testing still exist in these settings, and the full potential of POC testing cannot be realized until these limitations are addressed and resolved.

Staff and budget cutbacks and systemic changes in news media have been widely documented by journalists and scholars, and this qualitative study aims to understand the empirical experience of journalists outside the cities, where isolation, small staff, tight budgets and close communities are the rule. This article reports on part of a study that investigated the experience of journalists in remote and regional media outlets in Queensland and New South Wales. This article explores the more pointed ethical difficulties journalists experience in regional areas, finding these conundrums add layers to decision-making and complexity in the source?journalist relationships. Journalists in regional and remote areas report feeling pressure to take shortcuts in their story writing due to time restraints, to sensationalise or angle stories to suit management agendas, or to write clickbait headlines. They identified these as challenges to their professional practice.

This chapter situates choreographic practice of listening to Country in the lands of the Yawuru in Broome, north of Western Australia.  In this location the legacy of entangled Indigenous Asian histories have enabled the emergence of a choreopolitical neo-expressionism in Marrugeku’s dance theatre since 2003. The chapter examines Gudirr Gudirr (2013) a solo performance conceived and performed by Marrugeku’s Co-Artistic Director, Yawuru-Bardi-Malaysian-Filipino-Irish dancer and choreographer Dalisa Pigram. Gudirr Gudirr is co-created with Flemish choreographer and director Koen Augustijnen and Aboriginal-Malaysian-Chinese visual artist Vernon Ah Kee. The chapter outlines the uncanny affects of the intercultural in thick description of rehearsal and performance, detailed through the author’s perspective as dramaturg of the production. Swain proposes how this can revise and re-orientate choreography’s relation to kinetics, emotion and intergenerational responsibilities within political histories of place.